Healthcare access dimensions among ESRD patients in Northern Sudan: the critical affordability-malnutrition link during wartime 2024

Abstract Background Patients with end-stage renal disease (ESRD) undergoing haemodialysis are highly vulnerable in low-income, conflict-affected settings, where healthcare access is crucial for treatment continuity, complication prevention, and nutritional support. This study assessed healthcare access, its determinants, and the relationship with malnutrition in depth among ESRD patients in Northern State, Sudan. Methods This cross-sectional study involved a cluster sample of 141 ESRD patients from four dialysis centres in Northern Sudan. Healthcare access was measured using a structured questionnaire based on a modified Penchansky and Thomas model. Nutritional status was assessed via the Subjective Global Assessment (SGA). Data were analysed using descriptive statistics, bivariate tests, Analysis of Covariance (ANCOVA), and logistic regression in SPSS version 21, with statistical significance set at p-value < 0.05. Results Healthcare access was previously reported as moderate to high in this cohort. This secondary analysis found that age was a significant predictor of higher healthcare access: those aged ≥ 65 years had four times the odds of higher access compared to the youngest group (AOR = 3.87, 95% CI: 1.14–13.09; p < 0.05). While two-thirds of patients had health insurance, it was not a significant predictor of access level. In contrast, higher income significantly predicted higher access, with nearly tenfold greater odds (AOR = 9.997, 95%CI: 2.10-47.71; p < 0.05). Affordability was the weakest access dimension, with malnourished patients scoring significantly lower after adjustment for confounders (p-value < 0.05). Patients residing with their extended families were significantly less likely to have high-level access and more likely to have only moderate access (p-value < 0.001). Conclusion Although ESRD patients in Northern Sudan seem to have good access to healthcare, significant disparities persist. The relatively low affordability remains a major barrier, particularly for malnourished patients. Expanding targeted financing mechanisms could improve affordability, enhance early intervention, and promote more equitable access for this vulnerable population.